NHS executives have been planning to axe the Royal Surrey County Hospital’s A&E department for the last six months, a confidential report obtained by the Surrey Advertiser has revealed.

Senior officials within Surrey and Sussex Strategic Health Authority (SHA) were briefed as long ago as March about how the Royal Surrey should become “a local general hospital with specialist services”.

The SHA’s definition of a local general hospital is a site with what is described as an emergency care centre, effectively a walk-in unit, with routine elective surgery and midwifery-led obstetrics.

Months of research went into the 18-page document, which was provided to the SHA board “in strict confidence”.

It also presented SHA executives with “a choice” of closing one entire acute hospital site in either Surrey and Sussex as part of the bid to recover millions of pounds of NHS debt across the two counties.

For Surrey the SHA report outlined 13 potential options for the future of acute services, eight of which put the Royal Surrey in line to be downgraded and lose its casualty department.

However, it took until earlier this month for the man in charge of bringing about NHS reform in Surrey to confirm the prospect of the county having three A&Es, rather than the existing five.

Nick Yeo, the chief executive of North Surrey Primary Care Trust (PCT) and the Surrey transitional lead, said that no final decisions have been taken.

Six months ago the secret document compiled by the SHA, the regional arm of the Department of Health, set out a “preferred scenario”.

This would see the Royal Surrey lose out and become a local general hospital while St Peter’s in Chertsey and Frimley Park would retain the highest grade of accident and emergency care.

SHA studies looked at how the changes would meet various criteria and looked at travel times from across the county to A&E sites.

However, the estimations were based on journey times during office peak traffic periods. In Cranleigh, if the Royal Surrey lost its A&E, the nearest casualty department would be a minimum of 24 miles away at Frimley Park.

Candy Morris, the chief executive of South East Coast SHA, which took over control of the Surrey and Sussex SHA earlier this year, said the secret document looked at “potential acute hospital provision” and was not “necessarily endorsed by the NHS”.

“We believe the NHS has been very open about the challenges it faces in Surrey and Sussex,” Ms Morris explained.

“The fact remains that the NHS in Surrey and Sussex already receives £130 million above its ‘fair share’ and overspends significantly against this. We would like to make it clear that none of the work currently undertaken predetermines the outcome of the formal consultation process that is to be undertaken this autumn.

“The discussion to date has been about engaging stakeholders, clinicians and the public at an early stage to ensure that their views and ideas are considered in developing the options.”